PLEASE
PROVIDE THE FOLLOWING INFO: |
PURCHASER
INFORMATION: |
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Contact
Name |
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Contact
last name |
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Florist
Name |
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Address |
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City |
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State/Province |
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Zip/Postal
Code |
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Country |
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Business
Phone |
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Home
Phone |
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Cell
Phone |
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E-mail |
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RECIPIENT
INFORMATION: |
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CLICK
IF SAME AS PURCHASER AND SKIP THIS SECTION |
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Full
Name |
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Address |
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City |
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State/Province |
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Zip/Postal
Code |
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Country |
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Business
Phone |
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Home
Phone |
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Cell
Phone |
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E-mail |
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FEBRUARY 14,
VALENTINE'S DAY 2022 - ORANGE ROSES |
ORANGE
ROSES SELECT TYPE, SIZE AND QTY - EACH BUNCHE
CONTAINS 25 ROSES |
IGUANA: |
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QTY.
BUNCHES: |
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BOODOO: |
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QTY.
BUNCHES: |
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DONNA: |
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QTY.
BUNCHES: |
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MIRACLE: |
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QTY.
BUNCHES: |
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MOVIE
STAR: |
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QTY.
BUNCHES: |
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UNIQUE: |
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QTY.
BUNCHES: |
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SARI: |
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QTY.
BUNCHES: |
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STAR
2000: |
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QTY.
BUNCHES: |
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TROPICAL
AMAZON: |
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QTY.
BUNCHES: |
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VODOO: |
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QTY.
BUNCHES: |
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COMMENTS |
DELIVERY
DATE |
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PARTY'S
DAY 2022 - PEACH ROSES |
PEACH
ROSES SELECT TYPE, SIZE AND QTY - EACH BUNCHE
CONTAINS 25 ROSES |
CAMEL: |
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QTY.
BUNCHES: |
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DUETT: |
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QTY.
BUNCHES: |
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KRISTAL: |
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QTY.
BUNCHES: |
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OSIANA: |
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QTY.
BUNCHES: |
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PRIMA
DONNA: |
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QTY.
BUNCHES: |
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SAHARA: |
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QTY.
BUNCHES: |
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VERSILIA: |
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QTY.
BUNCHES: |
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COMMENTS |
DELIVERY
DATE |
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PARTY'S
DAY 2022 - PURPLE ROSES |
PURPLE
ROSES SELECT TYPE, SIZE AND QTY - EACH BUNCHE
CONTAINS 25 ROSES |
BLUE
BIRD: |
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QTY.
BUNCHES: |
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BLUE
CURIOSA: |
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QTY.
BUNCHES: |
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COOL
WATER: |
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QTY.
BUNCHES: |
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DELILAH: |
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QTY.
BUNCHES: |
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GOTCHA: |
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QTY.
BUNCHES: |
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MARITIM: |
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QTY.
BUNCHES: |
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PURPLE
CEZANNE: |
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QTY.
BUNCHES: |
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COMMENTS |
DELIVERY
DATE |
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PARTY'S
DAY 2022 - GREEN ROSES |
GREEN
ROSES SELECT TYPE, SIZE AND QTY - EACH BUNCHE
CONTAINS 25 ROSES |
ILIOS: |
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QTY.
BUNCHES: |
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JADE: |
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QTY.
BUNCHES: |
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KAMELEON: |
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QTY.
BUNCHES: |
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LIMBO: |
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QTY.
BUNCHES: |
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COMMENTS |
DELIVERY
DATE |
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PAYMENT
INFORMATION (DELIVERY AND FLORIDA TAXES CHARGES APPLIED) |
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Credit
card |
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Card
Number |
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Credit Card
Secure Code |
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(3 Numbers - see back of your Card) |
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Cardholder
Name |
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Cardholder
Billing Address |
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Complete of Zip Code |
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Expiration
Date |
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(MM/YY) |
SPECIFY
ANOTHER
PAYMENT METHOD: |
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CASH
ON DELIVERY: |
MONEY
ORDER: |
CASH
CHECK: |
CASH
IN ADVANCE: |
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OTHER:
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PLEASE
SPECIFY |
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We
will contact you via e-mail or phone shortly with your order
confirmation |
Please
verify your information carefully before submitting for
ordering |
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